Methods of Administering Ketamine
There are a number of methods to deliver Ketamine for mental health wellness. Here’s a simple overview of the different methods one can expect when working with Ketamine.
Sublingual Tablets or Troches (Pronounced Tro-keys)
Tablets or troches are compounded tablets by a pharmacy that are absorbed into the brain/bloodstream by allowing them to dissolve under the tongue, or held in the mouth. Sublingual dosing can vary from 10-350 milligrams (mg) per tablet on average, depending on the compounding pharmacy and the order from the clinician.
Tablets are the method utilized by clinicians here at The Attach Place, allowing for greater flexibility in treatment based on the client’s response to the medication. Tablets also provide an identical delivery mechanism as IV/IM but without the risk of infections or introducing harmful agents into the bloodstream.
A secondary benefit is there is a ceiling, an upper limit, to how much medicine an individual can absorb sublingually, making it nearly impossible to take larger doses than necessary.
IV Infusion or IM Injection
Intravenous (IV) infusions or Intramuscular (IM) ketamine injections have similar effects. The difference is that IV is typically infused into a vein with a bag that drips the substance in while IM is injected directly into the arm with a needle (similar to a flu shot). The dosage can be high in this methodology and requires medical supervision to maintain safety.
Ketamine nasal sprays are a synthesized mist stored in a spray bottle that is applied according to the delivery timeline outlined by the clinician. This is the latest delivery method to gain FDA approval with the introduction of Spravato. This is new and being shown highly effective for relief of suicidality in those who have persistent, high risk mental health symptoms.
The bioavailability and desired effect (sub-dissociative, sub-psychedelic, anesthetic) of each delivery method, which is the proportion of the compound that enters the body’s circulation, is what determines the typical dosing ranges. You can apply the highest doses (several thousand milligrams) with infusions, a mid-range with sublingual tablets (around 1000-1500mgs) and the lowest doses with nasal sprays.
The Attach Place uses Journey Clinical’s staff and pharmacy to create our client’s Ketamine troches. Admittedly, they do not taste great; however, some pharmacies do not try to create a pleasing lozenge. Journey Clinical is working diligently to improve the taste of the lozenge. Happily, each journey requires only 12 minutes of holding the medication in one’s mouth, a small discomfort for the value of the experience.